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Introduction: The heart rate variability (HRV) continually evolves throughout life, reflecting modifications in the architecture of the sinoatrial node (SAN) and in the regulation of heart rate by the autonomic nervous system (ANS). Both can be considerably affected by Chagas disease, causing important changes in the complex nature of HRV. We aim to evaluate the ability of an index based on the false nearest neighbors method (FN10) to reflect these changes during disease progression., Methods: We perform a retrospective, descriptive, and cross-sectional study analyzing HRV time series of participants with Chagas disease. We determine the dependence of FN10 on age and sex in a healthy population, and then evaluate FN10 in individuals with Chagas disease., Results and Discussion: In the healthy population, FN10 has a scaling behavior with age, which is independent of sex. In Chagas disease, some individuals show FN10 values significantly above those seen in the healthy population. We relate the findings to the pathophysiological mechanisms that determine the progression of the disease. The results indicate that FN10 may be a candidate prognostic biomarker for heart disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Defeo, Delaplace, Goin, Tersigni, Garavaglia and Irurzun.)

The prevalence of biofilm-associated microorganisms and the increasing use of ready-to-eat fresh products represent the current duality the food industry must address. Innovative and eco-friendly antibiofilm solutions and appropriate microbiological food control systems are urgently needed to improve food quality and safety. This study aimed to investigate the in vitro combined efficacy of carvacrol with a pre-formed biofilm monolayer of the probiotic Lactiplantibacillus plantarum DSM 20174. The antimicrobial activity of carvacrol against both planktonic and sessile cells of foodborne pathogens and spoilage microorganisms, alone or in the presence of the pre-formed biofilm of L. plantarum , was investigated by culture-based methods along with flow cytometry (FCM) to monitor cells' cultivability and viability. The synergistic action of carvacrol and the pre-formed biofilm of L. plantarum was evaluated in the 96-well plates. The results showed that L. plantarum pre-formed biofilm monolayer enhanced the antimicrobial effect of carvacrol determining a bactericidal action while the treatment alone induced the viable but not culturable (VBNC) cell state only. Furthermore, the great efficacy of the combined treatment allowed the application of a lower concentration of carvacrol (100 ppm) to achieve significant damage in cell viability. In conclusion, the incorporation of carvacrol into the L. plantarum pre-formed biofilm represents a promising alternative for an antimicrobial functionalized ready-to-eat packaging., Competing Interests: LG was employed by I.L.P.A. Group. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Poscente, Di Gregorio, Costanzo, Nobili, Bernini, Garavaglia and Bevivino.)

Background: Childhood dyskinesia (CD) is a complex movement disorder with components of dystonic and hyperkinetic nature, characterized by involuntary, sometimes stereotypical postures and gestures that are often impossible to control and hinder the execution of willful motion. The standard orthoses for the treatment of neurological diseases, including CD, are generally poorly differentiated for functional characteristics. The application of similar devices for movement disorders is far less generalized because of the very different symptoms, including the incapacity to control rather than initiate movement., Objectives: This article aims to describe an innovative method to fabricate personalized orthoses for the elbow-wrist joints in CD, taking into account anatomical and functional diversities. It also proposes functional elements to implement the required dynamic postural control., Methods: Wearable custom-made upper-limb orthoses have been fabricated and preliminarily tested on five patients with CD. Optoelectronic stereophotogrammetry was used as an innovative tool for all-in-one-frame acquisition of limb geometry. A new process for the functional personalization of the orthoses has been developed using shape memory alloys., Conclusions: The innovative method presented, encompassing data acquisition, virtual design, fabrication, and assembling, overcomes the problems due to the involuntary movements of the patients, which cannot be avoided during the fitting operations, providing comfortable and useful orthoses with minimal nuisance for the patients. Initial tests show that the orthoses were well tolerated by all the subjects; the promising comments of caregivers, together with improvements, were observed by the clinicians using specific clinical scales., (Copyright © 2022 International Society for Prosthetics and Orthotics.)

In this work we study the characteristics of heart rate variability (HRV) as a function of age and gender. Our analysis covers a wider age range than that studied so far. It includes results previously reported in the literature and reveals behaviours not reported before. We can establish basic scale relationships in different HRV measurements. The mean value of the RR intervals shows a power-law behaviour independent of gender. Magnitudes such as the standard deviation or pNN50 show abrupt changes at around the age of 12 years, and above that age they show gender dependence, which mainly affects short-time (or high frequency) scales. We present a unified analysis for the calculation of the non-linear α and β parameters. Both parameters depend on age; they increase in the extremes of life and reach a minimum at around one year of age. These gender-independent changes occur at low frequencies and in scale ranges that depend on age. The results obtained in this work are discussed in terms of the effects of basal metabolic rate, hormonal regulation, and neuronal activity on heart rate variability. This work finally discusses how these findings influence the interpretation of HRV measurements from records of different lengths., Competing Interests: The authors have declared that no competing interests exist.

Acute kidney injury is a reversible medical condition commonly caused by nephrotoxic agents. The infrequency that a nebulized medication elicits a renal insult presents a rare diagnostic challenge. Within this case, we report a 57-year-old cystic fibrosis patient with chronic kidney disease (CKD) Stage G3b (baseline 1.5-1.6 mg/dL) who developed an acute kidney injury (AKI) with a serum creatinine elevation to 4.08 mg/dL and associated worsening vestibular dysfunction related to twice-daily nebulized tobramycin inhalation solution (TIS). The patient was found to have a tobramycin serum level of 4.2 μg/mL 2.5 h after TIS dosing, with elevation remaining present at 1.1 μg/mL 24 h after discontinuation of therapy. Laboratory values at one month continued to show elevated creatinine levels at 2.1 mg/dL, suggesting progression of his baseline CKD. This case supports the benefit of obtaining tobramycin serum levels and vestibular/audiology function testing when evaluating patients on chronic nebulized TIS who present with acute or chronic renal dysfunction. From these serum levels, adjustments to daily dosing, regular monitoring of tobramycin serum levels, or discontinuation of treatment should be made to prevent permanent renal damage in patients with CKD. Calculated Naranjo ADR Probability Scale: 9; Definite.

Purpose: The chronic sequelae of stroke are often a strong limitation to patient's quality of life. New non-invasive elective treatments are required to support postural and functional improvements long after the primary insult. This study is an uncontrolled pilot evaluation of pseudoelastic orthotics for post-stroke upper-limb rehabilitation., Materials and Methods: Six chronic hemiplegic patients (3.8 ± 1.7 years since stroke) were evaluated with clinical scales, covering the ICF domains of body functions and structures (Modified Ashworth Score [MAS], Medical Research Council Scale for Muscle Strength, Fugl-Meyer [FM], Motricity Index [MI]), activities (Wolf Motor Function Test [WMF], Motor Activity Log [MAL]) and participation (quality of life questionnaires); sensors applied to the orthosis were used to assess changes in the articular and functional domains over a month's treatment., Results: Significant gains were achieved in elbow spasticity (MAS, p  = .020), upper-limb motor function (FM, p  = .005), reaching task ( p  = .035), and gait ( p  = .00046) speed. Most patients improved in functional tasks (WMF), but this did not reflect in daily-life activities as measured with MAL. Some patients reported an improved quality of life, especially the quality of sleep., Conclusions: Pseudoelastic orthoses could be a comfortable and useful adjunct in the long-term management of stroke. Broader trials will have to confirm these preliminary observations.Implications for rehabilitationUse of new materials in neuromuscular rehabilitation.Customised and adjustable therapeutic action obtained with dynamic personalised orthoses.Non-invasive interventions could be of help for patients with chronic disability.

Enzyme replacement therapy with idursulfase decreases morbidity and improves quality of life of patients with mucopolysaccharidosis ii. Immediate hypersensitivity reactions to this drug have been described. Desensitization is a treatment that induces temporary tolerance to a culprit drug, allowing the allergic patient to receive the medication. We present the case of a 7-year-old patient diagnosed with Hunter syndrome who presented, after 4 years of treatment, two episodes of anaphylaxis during the infusion of idursulfase. Detection of specific immunoglobulin E was carried out using skin tests, with intradermal reaction at a 1/10 dilution (0.2 mg/ml) being positive. A 12-step desensitization protocol was performed without presenting adverse events. The allergological evaluation and the possibility of desensitization were useful tools in the management of our patient., Competing Interests: None, (Sociedad Argentina de Pediatría.)

This study assessed the effect of the recently-introduced Life + (ILIP, Valsamoggia, Italy) active packaging system on the postharvest quality of sweet cherries and strawberries. This system uses Equilibrium Modified Atmosphere Packaging (EMAP) to achieve specific intra-package conditions with three synergistic elements: an unvented and anti-mist heat sealable container, an active (naturally-antimicrobial) pad, and a heat-sealed, laser micro-perforated film of a specified gas permeability. Post-packaging quality parameters were monitored for 10 (strawberries) and 15 days (cherries): headspace gas concentration, weight loss, titratable acidity, total soluble solids, pH, disease incidence, and sensory quality. Results showed that use of the Life + system delayed postharvest senescence by maintaining fruit color, acidity, and vitamin C content, and decreasing fruit weight loss and decay. The use of EMAP in sweet cherry resulted in enhanced sensory qualities compared to traditional perforated containers. The results suggest that the Life + system leads to better sensory properties and improved shelf-life for strawberries and sweet cherries., Competing Interests: The authors declare no conflict of interest

Distribution and abundance of charcoal in coal seams (in form of pyrogenic macerals of the inertinites group) have been considered as a reliable tool to interpret the local and regional palaeo-wildfire regimes in peat-forming depositional environments. Although the occurrence of inertinites is globally well documented for the Late Palaeozoic, the description of palaeobotanical evidence concerning the source plants of such charcoal is so far largely missing. In the present study, we provide the first detailed analysis of macro-charcoal preserved in the Barro Branco coal seam, Rio Bonito Formation, Cisuralian of the Paraná Basin, Santa Catarina State, Brazil. Charcoal, in form of macro-charcoal and inertinites, was documented in all the six coal-bearing strata that compose the succession, confirming the occurrence of recurrent palaeo-wildfires during its deposition. Reflectance values indicated a mean charring temperature reaching ~515°C (and up to 1,045°C in excess) and the macro-charcoal exhibits anatomical features of secondary xylem of Agathoxylon. Combination of results derived from palaeobotanical and petrological data demonstrates that gymnosperm-dominated vegetation was repeatedly submitted to fire events and reinforced the hypothesis that Gondwanan mires were high-fire systems during the Cisuralian., Competing Interests: The authors have declared that no competing interests exist.

Background: Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention., Main Body: This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis., Conclusions: Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.

The study proposes a new treatment for dystonia based on a dynamic wearable orthosis equipped with metallic materials of non-linear mechanical characteristics. Two boys with upper-limb dystonia were enrolled, as well as six healthy children. Fully-customised devices were made for the patients. They used the orthosis for one month and their performances were evaluated before and after the treatment. The assessment was done with clinical scales (Modified Ashworth Score, Melbourne Upper Limb Assessment, PedsQL), interviews and optoelectronic kinematic analysis. Normal kinematics was obtained from the healthy group for comparison. Kinematic analysis showed modifications in motor patterns for both patients, with increases in the ranges of motion of initially stiff segments, improvements in posture, emergence of multi-joint strategies. Clinical scales did not always show similar trends in the two cases. The changes in control strategies could be linked to the force field dynamically applied by the device and appear to be learnable. This interpretation will be further tested with larger groups and longer treatments.

Objectives: Patients with cystic fibrosis (CF) and pancreatic insufficiency are prescribed fat-soluble vitamins, although compliance remains low. Our objective was to identify patient and caregiver knowledge deficits regarding vitamin supplementation, provide targeted education, and examine serum vitamin levels pre-and posteducation., Methods: This prospective quality improvement study involved 118 patients. A vitamin knowledge survey was given to patients/caregivers during a clinic visit, education was provided targeting knowledge deficits, and the survey was re-administered at the next clinic visit. Serum vitamin levels were collected at pre- and postsurvey., Results: Results showed significant pre-post increases for patient and caregiver knowledge scores, and significant decreases in self-reported nonadherence to vitamin use and number of reported barriers affecting adherence. A significant change in vitamin E level to therapeutic range post-education was demonstrated., Conclusions: Our brief, targeted educational interventions regarding vitamin supplementation showed utility in a routine clinic setting.

Shape memory alloys (SMAs) are a very promising class of metallic materials that display interesting nonlinear properties, such as pseudoelasticity (PE), shape memory effect (SME) and damping capacity, due to high mechanical hysteresis and internal friction. Our group has applied SMA in the field of neuromuscular rehabilitation, designing some new devices based on the mentioned SMA properties: in particular, a new type of orthosis for spastic limb repositioning, which allows residual voluntary movement of the impaired limb and has no predetermined final target position, but follows and supports muscular elongation in a dynamic and compliant way. Considering patients in the sub-acute phase after a neurological lesion, and possibly bedridden, the paper presents a mobiliser for the ankle joint, which is designed exploiting the SME to provide passive exercise to the paretic lower limb. Two different SMA-based applications in the field of neuroscience are then presented, a guide and a limb mobiliser specially designed to be compatible with diagnostic instrumentations that impose rigid constraints in terms of electromagnetic compatibility and noise distortion. Finally, the paper discusses possible uses of these materials in the treatment of movement disorders, such as dystonia or hyperkinesia, where their dynamic characteristics can be advantageous.